Cash transfers: addressing barriers for people living with disabilities
Authors: Ana L Moncayo, Julia M Pescarini
Journal: The Lancet Public Health (2023)

Cash transfers have been used for decades as a means of reducing poverty and enhancing individuals' access to essential rights and needs, such as food, transportation, education, and health care.1Bastagli F Hagen-Zanker J Harman L Barca V Sturge G Schmidt T The impact of cash transfers: a review of the evidence from low- and middle-income countries.J Soc Policy. 2019; 48: 569-594Crossref Scopus (78) Google Scholar Although such programmes are not new (ie, many have been implemented in the early 1990s), many low-income and middle-income countries (LMICs) only designed social programmes for people with disabilities in the late 2000s, recognising the need for cash benefits during a specific period or throughout their lives.2Ullmann H Atuesta B Rubio García M Cecchini S Non-contributory cash transfers: an instrument to promote the rights and well-being of children with disabilities in Latin America and the Caribbean. Economic Commission for Latin America and the Caribbean (ECLAC), Santiago2021Google Scholar Poverty is an important factor contributing to the ongoing marginalisation of people living with disabilities, which strongly justifies the prioritisation of social protection interventions. People with disabilities could derive various benefits from cash assistance, including overcoming barriers they or their caregivers face in entering the job market or their inability to work. These barriers are also due to the disproportionate financial burden experienced by people with disabilities and their family members when accessing health-care services.2Ullmann H Atuesta B Rubio García M Cecchini S Non-contributory cash transfers: an instrument to promote the rights and well-being of children with disabilities in Latin America and the Caribbean. Economic Commission for Latin America and the Caribbean (ECLAC), Santiago2021Google Scholar Zhihui Li and colleagues3Li Z Wang H Chen S et al.The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities.Lancet Public Health. 2023; 8: e933-e942Summary Full Text Full Text PDF Google Scholar applied a well designed method to investigate the short-term and medium-term effects of China's disability-targeted cash transfer programme, known as the CT-PSD programme, on adults living with severe disabilities. Their findings indicated that the programme might alleviate some of the barriers faced by this group of individuals. Specifically, beneficiaries had lower odds of developing new disabilities and a reduced number of disabilities over time. These effects were partly attributed to the increased use of, and reduced financial barriers to, rehabilitation and medical services. Notably, the study showed that the programme had a strong positive impact on socially vulnerable subgroups, including people living in poverty and those residing in rural areas. This research builds on the authors' previous work, which showed that the receipt of cash transfers by children with disabilities was associated with an increased use of educational services and fewer financial barriers.4Wang H Li Z Chen S et al.The effect of a disability-targeted cash transfer program on universal health coverage and universal access to education: a nationwide cohort study of Chinese children and adolescents with disabilities.Lancet Reg Health West Pac. 2022; 31100635Google Scholar Although Li and colleagues3Li Z Wang H Chen S et al.The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities.Lancet Public Health. 2023; 8: e933-e942Summary Full Text Full Text PDF Google Scholar were only able to explore one pathway in which cash transfers might positively affect disability status (ie, improved access to rehabilitation and medical services), in the context of limited evaluations of the impact of cash transfers targeted at people with disabilities on health-care access and health outcomes, such evaluations studies3Li Z Wang H Chen S et al.The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities.Lancet Public Health. 2023; 8: e933-e942Summary Full Text Full Text PDF Google Scholar, 4Wang H Li Z Chen S et al.The effect of a disability-targeted cash transfer program on universal health coverage and universal access to education: a nationwide cohort study of Chinese children and adolescents with disabilities.Lancet Reg Health West Pac. 2022; 31100635Google Scholar contribute to our broader understanding of the potential pathways through which cash benefits can improve the overall quality of life for people with disabilities. These pathways include enhancing people's nutritional status and physical and mental health, fostering independence and a sense of belonging, and ultimately, indirectly benefiting the health and wellbeing of the entire family, particularly caregivers. Nevertheless, some considerations should be acknowledged when contemplating the potential impacts of disability-related cash benefits. Eligibility for programmes such as the CT-PSD programme might vary across administrative regions, not only in China but also in other LMICs, where the accessibility and quality of health-care services vary substantially by region and type of service.5Coube M Nikoloski Z Mrejen M Mossialos E Persistent inequalities in health care services utilisation in Brazil (1998–2019).Int J Equity Health. 2023; 22: 25Crossref PubMed Scopus (0) Google Scholar Consequently, the beneficial effects of cash transfers might be more pronounced in areas where programmes are better managed,6Ramos D da Silva NB Ichihara MY et al.Conditional cash transfer program and child mortality: a cross-sectional analysis nested within the 100 Million Brazilian Cohort.PLoS Med. 2021; 18e1003509Crossref PubMed Scopus (15) Google Scholar or where the only barrier to accessing medical or rehabilitation services is financial. To optimise programme effectiveness, cash benefits targeting people with disabilities should ideally be integrated into a comprehensive array of services and interventions designed to enhance their quality of life and promote inclusion, all supported by a rights-based approach.7Goudge J Russell S Gilson L Gumede T Tollman S Mills A Illness-related impoverishment in rural South Africa: why does social protection work for some households but not others?.J Int Dev. 2009; 21: 231-251Crossref Scopus (47) Google Scholar Furthermore, such cash benefits should focus on addressing the long-term financial needs and instabilities that disabilities pose to individuals' lives, rather than solely addressing immediate poverty. Some disabilities are complex and might necessitate long-term or lifelong rehabilitation, which can have a profound impact on labour participation and the living conditions of affected families. Finally, although the authors were able to account for characteristics that are typically unavailable in other databases, such as the type and severity of disability, propensity score matching cannot fully mitigate all selection biases inherent to such studies. When examining policies that require active registration of people with disabilities or their caregivers to receive benefits, it is essential to consider who might have been excluded from these registries and policies, and, consequently, from the evaluations. Recognising that the programme was not universally implemented but gradually rolled out on the basis of local administration, understanding the mechanisms driving variations in registration levels, and knowing the speed of implementation in different areas are all crucial aspects to consider. These factors can help explain variations in the overall impact of the programme across regions. Leaving no one behind, as outlined in the UN Sustainable Development Agenda, entails implementing and adapting policies to achieve equity. The study by Li and colleagues3Li Z Wang H Chen S et al.The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities.Lancet Public Health. 2023; 8: e933-e942Summary Full Text Full Text PDF Google Scholar substantially contributes to closing the knowledge gap regarding the effects of cash transfers on individuals with disabilities, particularly regarding their access to health care and disability status. This evidence will undoubtedly have a pivotal role in guiding future evaluations of disability-related benefits in LMICs and worldwide. We declare no competing interests. During the preparation of this work, JMP used ChatGPT to proofread the manuscript. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilitiesThe receipt of cash transfers was associated with improved disability status and increased access to disability-related services. The findings suggest that cash transfers could be a potential method for promoting universal health coverage among individuals living with disabilities. Full-Text PDF Open Access